金属支架置入联合腹腔镜手术治疗左半结肠癌、直肠癌梗阻

目的探讨左半结肠癌、直肠癌梗阻患者支架置入后腹腔镜手术的安全性和可行性。方法2009年3月～2013年4月43例左半结肠癌、直肠癌梗阻根据患者及家属意愿选择手术方式，分为支架联合腹腔镜手术25例（支架腹腔镜组），术中大肠灌洗一期切除吻合术18例（一期吻合组），比较2组手术时间、住院时间、术中出血量、吻合口漏、切口感染、腹腔感染等。结果支架腹腔镜组术中出血量（40．5±20．1）ml，明显少于一期吻合组（280．8±20．6）ml（t=-38．277，P=0．000）；手术时间（135．2±25．4）rain，明显短于一期吻合组（240．4±30．5）min（t=-12．317，P=0．000）；吻合口漏0例，显著少于一期吻合组4例（Fisher’s检验，P=0．025）；切口感染0例，显著少于一期吻合组8例（Fisher’s检验，P=0．000）；腹腔感染0例，显著少于一期吻合组6例（Fisher’s检验，P=0．003）；住院时间（19．5±3．3）d与一期吻合组（20．2±8．5）d无明显差异（t=0．376，P=0．709）。2组患者术后6。12个月随访，恢复良好，无吻合口复发。结论左半结肠癌、直肠癌梗阻患者支架置入后7—10d腹腔镜手术安全可行，术后恢复快，并发症少。

Laparoscopic Surgery Combined with Colon Bracket Insertion for Cancerous Obstruction of Left Hemicolon and Rectum

Objective To study the safety and feasibility of laparoscopic surgery after colon bracket insertion in the treatment of cancerous obstruction of left hemicolon and rectum. Methods A total of 43 cases of obstructing left-sided colon cancer or rectal cancer from March 2009 to April 2013 were reviewed. According to patients＇ preference, all the cases were divided into two groups： 25 cases received laparoscopic surgery 7 - 10 days after the placement of the self-expanding metal stent （laparoscopic group）, while 18 cases were treated by one-stage radical colon resection after colon irrigation （ open group）. The operative time, the length of hospital stay, blood loss, anastomotic leakage, wound infection, and abdominal infection were compared between the two groups. Results The laparoscopie group had significantly less intraoperative blood loss [ （40.5 ± 20.1 ） ml vs. （280.8 ± 20.6 ） ml, t = - 38. 277, P = 0. 000 ], shorter operation time [ （ 135.2 ± 25.4） rain vs. （240.4 ± 30.5） min, t = - 12. 317, P = 0. 000 ], fewer anastomotic leakage （0 case vs. 4 cases, Fisher＇ s test,P =0. 025） , fewer wound infection （0 case vs. 8 cases,Fisher＇ s test, P =0. 000） , and fewer abdominal infection （0 case vs. 6 cases,Fisher＇ s test, P = 0. 003） than those of the open group. No significant difference was detected in the hospital stay between the two groups [ （19.5 ±3.3） d vs. （20.2 ± 8.5） d, t =0. 376, P =0. 7091. Both the groups were followed up for 6 - 12 months after operation. None of the patients showed postoperative anastomotie recurrence. Conclusion Laparoscopie surgery 7 - 10 days after colon bracket insertion is effective and safe, having quick postoperative recovery and less complications.